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Typical and atypical presenting symptoms of breast cancer and their associations with diagnostic intervals: Evidence from a national audit of cancer diagnosis

Lookup NU author(s): Emeritus Professor Greg RubinORCiD



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


© 2017 The Author(s)Introduction Most symptomatic women with breast cancer have relatively short diagnostic intervals but a substantial minority experience prolonged journeys to diagnosis. Atypical presentations (with symptoms other than breast lump) may be responsible. Methods We examined the presenting symptoms of breast cancer in women using data from a national audit initiative (n = 2316). Symptoms were categorised topographically. We investigated variation in the length of the patient interval (time from symptom onset to presentation) and the primary care interval (time from presentation to specialist referral) across symptom groups using descriptive analyses and quantile regression. Results A total of 56 presenting symptoms were described: breast lump was the most frequent (83%) followed by non-lump breast symptoms, (e.g. nipple abnormalities (7%) and breast pain (6%)); and non-breast symptoms (e.g. back pain (1%) and weight loss (0.3%)). Greater proportions of women with ‘non-lump only’ and ‘both lump and non-lump’ symptoms waited 90 days or longer before seeking help compared to those with ‘breast lump only’ (15% and 20% vs. 7% respectively). Quantile regression indicated that the differences in the patient interval persisted after adjusting for age and ethnicity, but there was little variation in primary care interval for the majority of women. Conclusions About 1 in 6 women with breast cancer present with a large spectrum of symptoms other than breast lump. Women who present with non-lump breast symptoms tend to delay seeking help. Further emphasis of breast symptoms other than breast lump in symptom awareness campaigns is warranted.

Publication metadata

Author(s): Koo MM, von Wagner C, Abel GA, McPhail S, Rubin GP, Lyratzopoulos G

Publication type: Article

Publication status: Published

Journal: Cancer Epidemiology

Year: 2017

Volume: 48

Pages: 140-146

Print publication date: 01/06/2017

Online publication date: 23/05/2017

Acceptance date: 18/04/2017

Date deposited: 01/09/2017

ISSN (print): 1877-7821

ISSN (electronic): 1877-783X

Publisher: Elsevier Ltd


DOI: 10.1016/j.canep.2017.04.010


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